Incomplete diagnostic investigation and failure to get the best treatment are the most likely reasons why survival for bowel cancer patients is lower in the UK than in other comparable countries, according to new research published in the journal Acta Oncologica.

The research, led by the London School of Hygiene & Tropical Medicine, was carried out in Australia, Canada, Denmark, Norway, Sweden and the UK for the International Cancer Benchmarking Partnership (ICBP). The study included more than 310,000 bowel cancer patients diagnosed during 2000-07.

Bowel cancer is sometimes called colorectal cancer, which includes cancers of the colon and rectum. This study examined both types of bowel cancer.

The researchers examined how far the patients' cancer had spread at the time of diagnosis - from very early (localised, stage A) to very late (spread to other parts of the body, stage D). They also examined the proportion of patients at each stage of disease who survived for one year and three years after diagnosis, after correction for the impact of other causes of death.

Two-thirds (67%) of colon cancer patients in the UK survived for at least one year, compared with 80% in Sweden. Three-quarters (75%) of rectal cancer patients in the UK survived for one year or more, compared with 84% in Sweden.

Low overall survival in a particular country can arise either because the patients there tend to be diagnosed at a later stage of disease than in other countries, or because survival at each stage of disease is lower than in other countries.

The proportion of colon cancer patients diagnosed at the earliest stage (stage A) was lowest in the UK - only 8% compared with 11-17% elsewhere. But UK patients were also less likely to be diagnosed at the most advanced stage (20% at stage D, compared with 24-31% elsewhere).

For both colon and rectal cancer, survival among UK patients diagnosed at the earliest stage of disease (stage A) was similar to that in the other five countries (96%, compared to 92-98% elsewhere), but survival in the UK was consistently lower for those diagnosed at a more advanced stage (5-11% lower than elsewhere).

The researchers used population-based data for all patients diagnosed in a given country or region, not just the small proportion of patients included in clinical trials. The international differences in survival may arise from differences in the availability or use of diagnostic tests, and in the use of surgery, chemotherapy or radiotherapy at each stage of diagnosis. Countries do not all collect information on stage at diagnosis in the same way, however, and this can cause artefacts in international survival comparisons.

Camille Maringe, lead author based at the Cancer Research UK Cancer Survival Group at the London School of Hygiene & Tropical Medicine, said: "Accurate investigation of how far the cancer has spread (the stage) when it is diagnosed is essential for clinicians to be able to offer their patients the most appropriate treatment. This will increase survival. Investigation does not appear to be as thorough in the UK as in other countries, and except for patients with local tumours, survival is lower than in other countries at each stage of disease.

"We observed international differences in survival at each stage of disease. These differences are wider for older patients, and for patients whose disease is very advanced when they are diagnosed.

"Improvements are urgently needed in the quality and thoroughness of the medical tests that are used to assess the stage at diagnosis for each patient. The data collected by cancer registries on stage at diagnosis also need to be more accurate and complete. This will enable more accurate international comparisons of survival at each stage of disease. In turn, it will enable patients, doctors and healthcare planners to see which countries are setting the best standards, and what improvements are required to reach the highest levels of survival."

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3. The stage at diagnosis indicates how large the cancer is, and how far it has spread when diagnosed. One of the most widely used international system for classifying the stage of bowel cancer is called Dukes' stage. This includes four stages (A-D), from tumours that are more or less localised (A, B), to those that have spread to the lymph nodes (C) or other parts of the body (D: secondary cancer or metastases).

About the International Cancer Benchmarking Partnership (ICBP)

The International Cancer Benchmarking Partnership (ICBP) is a unique and innovative global partnership of clinicians, academics and policymakers. The ICBP is funded by the UK Department of Health and Cancer Research UK. http://www.icbp.org.uk

About Cancer Research UK

Cancer Research UK is the world's leading cancer charity dedicated to saving lives through research

The charity's pioneering work into the prevention, diagnosis and treatment of cancer has helped save millions of lives.

Cancer Research UK receives no government funding for its life-saving research. Every step it makes towards beating cancer relies on every pound donated.

Cancer Research UK has been at the heart of the progress that has already seen survival rates in the UK double in the last forty years.

Cancer Research UK supports research into all aspects of cancer through the work of over 4,000 scientists, doctors and nurses.

Together with its partners and supporters, Cancer Research UK's vision is to bring forward the day when all cancers are cured.

For further information about Cancer Research UK's work or to find out how to support the charity, please call 0300 123 1022 or visit http://www.cancerresearchuk.org.

About the London School of Hygiene & Tropical Medicine

The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 3,500 students and more than 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and was recently cited as one of the world's top universities for collaborative research. The School's mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. http://www.lshtm.ac.uk

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